Provider Demographics
NPI:1306071279
Name:AGUIRRE, LISA J
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 W ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2736
Mailing Address - Country:US
Mailing Address - Phone:307-634-3650
Mailing Address - Fax:307-638-0467
Practice Address - Street 1:1519 W ALLISON RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-2736
Practice Address - Country:US
Practice Address - Phone:307-634-3650
Practice Address - Fax:307-638-0467
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator